Journal
MOVEMENT DISORDERS
Volume 29, Issue 10, Pages 1258-1264Publisher
WILEY-BLACKWELL
DOI: 10.1002/mds.25924
Keywords
Parkinson's disease; Parkinson's disease with dementia; cognition; assessment of cognitive disorders/dementia; mild cognitive impairment
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Funding
- Department of Veterans Affairs
- American Parkinson Disease Association
- Consolidated Anti-Aging Foundation
- National Institutes of Health [P50 NS062684, P50 NS053488, P50 NS038367, R01 NS065070, RO1 ES010544]
- Northwest Collaborative Care
- Jane and Lee Seidman Fund
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Cognitive impairment, including dementia, is common in Parkinson's disease (PD). The Mini-Mental State Examination (MMSE) has been recommended as a screening tool for Parkinson's disease dementia (PDD), with values below 26 indicative of possible dementia. Using a detailed neuropsychological battery, we examined the range of cognitive impairment in PD patients with an MMSE score of 26 or higher. In this multicenter, cross-sectional, observational study, we performed neuropsychological testing in a sample of 788 PD patients with MMSE scores of 26 or higher. Evaluation included tests of global cognition, executive function, language, memory, and visuospatial skills. A consensus panel reviewed results for 342 subjects and assigned a diagnosis of no cognitive impairment, mild cognitive impairment, or dementia. Sixty-seven percent of the 788 subjects performed 1.5 standard deviations below the normative mean on at least one test. On eight of the 15 tests, more than 20% of subjects scored 1.5 standard deviations or more below the normative mean. Greatest impairments were found on Hopkins Verbal Learning and Digit Symbol Coding tests. The sensitivity of the MMSE to detect dementia was 45% in a subset of participants who underwent clinical diagnostic procedures. A remarkably wide range of cognitive impairment can be found in PD patients with a relatively high score on the MMSE, including a level of cognitive impairment consistent with dementia. Given these findings, clinicians must be aware of the limitations of the MMSE in detecting cognitive impairment, including dementia, in PD. (C) 2014 International Parkinson and Movement Disorder Society
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